Which clinical finding is least likely to be associated with rheumatoid arthritis?

Elevation of alkaline phosphatase is least likely to be associated with rheumatoid arthritis. Rheumatoid arthritis is primarily an inflammatory condition that primarily affects the joints, leading to symptoms such as pain, swelling, and deformities. The presence of ulnar deviation, synovial swelling, and formation of rheumatoid nodules are classic manifestations of this disease.

Ulnar deviation occurs due to the destruction of the joints and the resultant weakening of the collateral ligaments, which causes the fingers to drift toward the ulnar side. Synovial swelling reflects the inflammation and hyperplasia of the synovial membrane, leading to the classic presentation of swollen joints. Rheumatoid nodules are firm, painless subcutaneous lumps that typically develop in areas subject to pressure in individuals with chronic rheumatoid arthritis.

In contrast, alkaline phosphatase is an enzyme associated with liver and bone disease, and its elevation is more commonly linked to other conditions such as liver dysfunction or bone disease like Paget's disease and osteomalacia. While some patients with rheumatoid arthritis may have elevated alkaline phosphatase levels due to secondary changes or coexisting conditions, it is not a direct or typical clinical finding of rheumatoid arthritis itself.